1
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Rudic B, Borggrefe M. [Historical developments in the diagnosis and treatment of pre-excitation syndromes (WPW)]. Herzschrittmacherther Elektrophysiol 2024; 35:118-126. [PMID: 38427036 PMCID: PMC10923739 DOI: 10.1007/s00399-024-01000-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
In 1930, Wolff, Parkinson and White described the syndrome that bears their names. The mechanisms of supraventricular tachycardias were analyzed by brilliant electrocardiography interpretation by Pick and Langendorf. Wellens and Durrer using electrophysiologic studies analyzed the tachycardia mechanism invasively. In Germany the group by Seipel and Breithardt as well as Neuss and Schlepper studied the tachycardia mechanisms and response to antiarrhythmic drugs invasively by electrophysiological studies. Following the first successful interruption of an accessory pathway by Sealy in 1967, surgeons and electrophysiologists cooperated in Germany. Two centers, Hannover and Düsseldorf were established. Direct current (DC) ablation of accessory pathways was introduced by Morady and Scheinman. Because of side effects induced by barotrauma of DC, alternative strategies were studied. In 1987, radiofrequency ablation was introduced and thereafter established as curative therapy of accessory pathways in all locations.
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Affiliation(s)
- Boris Rudic
- I. Medizinische Klinik, Universitätsmedizin Mannheim, 68167, Mannheim, Theodor-Kutzer-Ufer 1-3, Deutschland.
| | - Martin Borggrefe
- I. Medizinische Klinik, Universitätsmedizin Mannheim, 68167, Mannheim, Theodor-Kutzer-Ufer 1-3, Deutschland.
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2
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Leung LW, Evranos B, Gonna H, Harding I, Domenichini G, Gallagher MM. Multi-catheter cryotherapy for the treatment of resistant accessory pathways. Indian Pacing Electrophysiol J 2024; 24:1-5. [PMID: 37977548 PMCID: PMC10927982 DOI: 10.1016/j.ipej.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To investigate the utility of simultaneous multi-catheter cryotherapy for the treatment of APs that were previously resistant to standard radiofrequency (RF) catheter ablation. BACKGROUND Catheter ablation is established in the treatment of accessory pathways (AP), with high rates of permanent procedural success with a single attempt. However, there are still instances of acute procedural failure and AP recurrences with standard RF and cryotherapy methods. METHODS Seven consecutive cases of pre-excitation syndromes with prior failed RF catheter ablation had the novel treatment. Cryotherapy was delivered using two 8 mm tip focal cryoablation catheters (Freezor® Max, Medtronic, Minneapolis, Minnesota, USA). RESULTS Accessory pathway localisation was septal in 5 cases, left posterolateral in 1, right lateral in 1. In all cases, ablation of the AP was acutely successful with no procedural complications. Median procedure and fluoroscopy durations were 199 and 35 min, sequentially. Median Procedure duration fell significantly in the second half of series (174 min) compared to the first half (233 min, P = 0.05). One patient had evidence of a recurring AP conduction with pre-excitation at 5-week follow up. After a median follow up of 66.8+-6.5 months, 6 out of 7 patients remained asymptomatic and free of pre-excitation. CONCLUSION Simultaneous multi-catheter cryotherapy is feasible, safe and can provide definitive cure of accessory pathways that were previously resistant to standard radiofrequency ablation. Further study is required in the assessment of this novel form of advanced cryotherapy to treat complex and resistant arrhythmias.
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Affiliation(s)
- Lisa Wm Leung
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK
| | - Banu Evranos
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK
| | - Hanney Gonna
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK
| | - Idris Harding
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK
| | - Giulia Domenichini
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK
| | - Mark M Gallagher
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK.
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3
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Xiong N, Gu W, Li J, Scheinman MM. A tortuous tale of tachycardia termination. Heart Rhythm 2023; 20:1457-1458. [PMID: 37777304 DOI: 10.1016/j.hrthm.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 10/02/2023]
Affiliation(s)
- Nanqing Xiong
- Department of Cardiology, Huashan Hospital Fudan University, Shanghai, China
| | - Wentao Gu
- Department of Cardiology, Huashan Hospital Fudan University, Shanghai, China
| | - Jian Li
- Department of Cardiology, Huashan Hospital Fudan University, Shanghai, China
| | - Melvin M Scheinman
- Division of Electrophysiology, Department of Cardiology, University of California San Francisco, San Francisco, California.
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4
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Meziab O, Dionne A, Przybylski R, Triedman JK, Walsh EP, Mah DY. Clinical implications of a unique delta wave pattern in patients with left-sided Wolff-Parkinson-White. Europace 2023; 25:euad104. [PMID: 37070604 PMCID: PMC10228622 DOI: 10.1093/europace/euad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/27/2023] [Indexed: 04/19/2023] Open
Affiliation(s)
- Omar Meziab
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Audrey Dionne
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Robert Przybylski
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - John K Triedman
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Edward P Walsh
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Douglas Y Mah
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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5
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Uniat J, Silka MJ. Risk assessment of pre-excitation: Atrial fibrillation versus atrial flutter. HeartRhythm Case Rep 2022; 9:31-33. [PMID: 36685684 PMCID: PMC9845542 DOI: 10.1016/j.hrcr.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jonathan Uniat
- Address reprint requests and correspondence: Dr Jonathan Uniat, Children’s Hospital Los Angeles, 4650 Sunset Blvd, MS #34, Los Angeles, CA 90027.
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6
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Jemtrén A, Bergfeldt L, Insulander P, Rubulis A, Tapanainen J, Jensen-Urstad M. Accessory pathway properties are similar in symptomatic and asymptomatic preexcitation. J Interv Card Electrophysiol 2022; 65:193-199. [PMID: 35618980 PMCID: PMC9550742 DOI: 10.1007/s10840-022-01252-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 05/09/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Patients with WPW syndrome have an increased mortality rate compared to the general population. Although asymptomatic preexcitation has previously been considered benign, recent studies have found that also asymptomatic patients have clinical and electrophysiological factors associated with increased risk of sudden cardiac death. This study compares the baseline electrophysiological characteristics of accessory pathways in symptomatic and asymptomatic patients with preexcitation. We hypothesized that a significant proportion of asymptomatic patients has inducible orthodromic tachycardia during programmed electrical stimulation. METHODS This retrospective study includes 1853 patients with preexcitation who underwent invasive electrophysiological testing in two Swedish University Hospitals between 1991 and 2018. The mean age was 36 ± 17 years with a range of 3-89 years. Thirty-nine percent was women. A total of 269 patients (15%) were children younger than 18 years. Electrophysiological data included effective refractory period of the accessory pathway (APERP, in 1069 patients), tachycardia cycle length, inducibility and type of tachycardia, and AP localization. RESULTS A total of 1703 (93%) patients reported symptoms suggesting tachyarrhythmias before the study and 128 (7%) were asymptomatic. The proportion of potentially dangerous pathways with short APERP (≤ 250 ms) were similar in symptomatic and asymptomatic patients (187/949, 20% vs. 25/108, 23%) (P = 0.40) as was the mean APERP (303 ± 68 ms vs. 307 ± 75) (P = 0.61). The proportion of patients who had inducible arrhythmia was larger in the symptomatic group (64% vs. 31%) (P < 0.001). CONCLUSION The results of this study strengthen the present guideline recommendation (IIA) to consider invasive risk assessment in patients with asymptomatic preexcitation.
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Affiliation(s)
- Anette Jemtrén
- Department of Cardiology, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Lennart Bergfeldt
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per Insulander
- Department of Cardiology, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Aigars Rubulis
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jari Tapanainen
- Department of Cardiology, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Mats Jensen-Urstad
- Department of Cardiology, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden.
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7
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Lange RA, Nguyen V, Abedin Z. Pre-excitation Due to Fascicular-Ventricular Pathway: An Electrocardiographic Diagnosis: A Case Report. J Investig Med High Impact Case Rep 2022; 10:23247096211073261. [PMID: 35045738 PMCID: PMC8785281 DOI: 10.1177/23247096211073261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 79-year-old Caucasian male was referred to cardiology clinic because the electrocardiogram showed premature atrial complexes and pre-excitation (delta waves) thought to be consistent with Wolff-Parkinson-White (WPW) syndrome. He did not report symptoms of palpitations or syncope. Careful analysis of the electrocardiogram revealed a fascicular-ventricular pathway (FVP) responsible for pre-excitation. Differentiating FVP from WPW syndrome is essential as the risk profile is different with each. Electrocardiographic observations that could help identify the presence of an FVP and its diagnostic, prognostic, and therapeutic implications are presented.
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Affiliation(s)
| | | | - Zainul Abedin
- Texas Tech University Health Sciences Center El Paso, USA
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8
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Farré J, Anderson RH, Sánchez-Quintana D, Mori S, Rubio JM, García-Talavera C, Bansal R, Lokhandwala Y, Cabrera JA, Wellens HJJ, Sternick EB. Miniseries 2-septal and paraseptal accessory pathways-part II: para-Hisian accessory pathways-so-called anteroseptal pathways revisited. Europace 2022; 24:650-661. [PMID: 34999787 DOI: 10.1093/europace/euab293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 11/08/2021] [Indexed: 11/12/2022] Open
Abstract
Surgeons, when dividing bypass tracts adjacent to the His bundle, considered them to be 'anteroseptal'. The area was subsequently recognized to be superior and paraseptal, although this description is not entirely accurate anatomically, and conveys little about the potential risk during catheter interventions. We now describe the area as being para-Hisian, and it harbours two types of accessory pathways. The first variant crosses the membranous septum to insert into the muscular ventricular septum without exiting the heart, and hence being truly septal. The second variant inserts distally in the paraseptal components of the supraventricular crest, and consequently is crestal. The site of ventricular insertion determines the electrocardiographic expression of pre-excitation during sinus rhythm, with the two types producing distinct patterns. In both instances, the QRS and the delta wave are positive in leads I, II, and aVF. In crestal pathways, however, the QRS is ≥ 140 ms, and exhibits an rS configuration in V1-2. The delta wave in V1-2 precedes by 20-50 ms the apparent onset of the QRS in I, II, III, and aVF. In the true septal pathways, the QRS complex occupies ∼120 ms, presenting a QS, W-shaped, morphology in V1-2. The delta wave has a simultaneous onset in all leads. Our proposed terminology facilitates the understanding of the electrocardiographic manifestations of both types of para-Hisian pathways during pre-excitation and orthodromic tachycardia, and informs on the level of risk during catheter ablation.
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Affiliation(s)
- Jerónimo Farré
- Fundación Jiménez Díaz University Hospital, Institute of Biomedical Research, Madrid, Spain
| | - Robert H Anderson
- Institute of Biosciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Shumpei Mori
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - José-Manuel Rubio
- Fundación Jiménez Díaz University Hospital, Institute of Biomedical Research, Madrid, Spain
| | - Camila García-Talavera
- Fundación Jiménez Díaz University Hospital, Institute of Biomedical Research, Madrid, Spain
| | - Raghav Bansal
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - José-Angel Cabrera
- Unidad de Arritmias, Departamento de Cardiología, Hospital Universitario Quirón-Salud, Madrid, Spain.,Complejo Hospitalario Ruber Juan Bravo, Universidad Europea de Madrid, Madrid, Spain
| | - Hein J J Wellens
- CARIM-Cardiovascular Research Centre, Maastricht, The Netherlands
| | - Eduardo Back Sternick
- Arrhythmia and Electrophysiology Department, Biocor Instituto, Nova Lima, Minas Gerais, Brazil
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9
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Farré J, Anderson RH, Rubio JM, García-Talavera C, Sánchez-Quintana D, Bansal R, Lokhandwala Y, Cabrera JA, Wellens HJJ, Back Sternick E. Miniseries 2-septal and paraseptal accessory pathways-part III: mid-paraseptal accessory pathways-revisiting bypass tracts crossing the pyramidal space. Europace 2022; 24:662-675. [PMID: 34999785 DOI: 10.1093/europace/euab294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 11/08/2021] [Indexed: 11/12/2022] Open
Abstract
The mid-paraseptal region corresponds to the portion of the pyramidal space whose right atrial aspect is known as the triangle of Koch. The superior area of this mid-paraseptal region is also para-Hisian, and is close to the compact atrioventricular node and the His bundle. The inferior sector of the mid-paraseptal area is unrelated to the normal atrioventricular conduction pathways. It is, therefore, a safe zone in which, if necessary, to perform catheter ablation. The middle part of the mid-paraseptal zone may, however, in some patients, house components of the compact atrioventricular node. This suggests the need for adopting a prudent attitude when considering catheter ablation in this area. The inferior extensions of the atrioventricular node, which may represent the substrate for the slow atrioventricular nodal pathway, take their course through the middle, and even the inferior, sectors of the mid-paraseptal region. In this review, we contend that the middle and inferior areas of the mid-paraseptal region correspond to what, in the past, was labelled by most groups as the 'midseptal' zone. We describe the electrocardiographic patterns observed during pre-excitation and orthodromic reciprocating tachycardia in patients with pathways ablated in the middle or inferior sectors of the region. We discuss the modification of the ventriculo-atrial conduction times during tachycardia after the development of bundle branch block aberrancy. We conclude that the so-called 'intermediate septal' pathways, as described in the era of surgical ablation, were insufficiently characterized. They should not be considered the surrogate of the 'midseptal' pathways defined using endocardial catheter electrode mapping.
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Affiliation(s)
- Jerónimo Farré
- Fundación Jiménez Díaz University Hospital, Institute of Biomedical Research, Madrid, Spain
| | - Robert H Anderson
- Institute of Biosciences, Newcastle University, Newcastle upon Tyne, UK
| | - José-Manuel Rubio
- Fundación Jiménez Díaz University Hospital, Institute of Biomedical Research, Madrid, Spain
| | - Camila García-Talavera
- Fundación Jiménez Díaz University Hospital, Institute of Biomedical Research, Madrid, Spain
| | | | - Raghav Bansal
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - José-Angel Cabrera
- Unidad de Arritmias, Departamento de Cardiología, Hospital Universitario Quirón-Salud, Madrid, Spain.,Universidad Europea, Madrid, Spain
| | - Hein J J Wellens
- CARIM-Cardiovascular Research Centre, Maastricht, The Netherlands
| | - Eduardo Back Sternick
- Arrhythmia and Electrophysiology Unit, Biocor Instituto, Nova Lima, Minas Gerais, Brazil
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10
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Farré J, Anderson RH, Rubio JM, Tretter JT, Sánchez-Quintana D, García-Talavera C, Bansal R, Lokhandwala YY, Cabrera JA, Wellens HJJ, Back Sternick E. Miniseries 2-septal and paraseptal accessory pathways-part IV: inferior paraseptal accessory pathways-lessons from surgical and catheter ablation. Europace 2022; 24:676-690. [PMID: 34999773 DOI: 10.1093/europace/euab295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 11/08/2021] [Indexed: 11/14/2022] Open
Abstract
Surgeons and electrophysiologists performing accessory pathway ablation procedures have used the term 'posteroseptal' region. This area, however, is neither septal nor posterior, but paraseptal and inferior; paraseptal because it includes the fibro-adipose tissues filling the pyramidal space and not the muscular septum itself and inferior because it is part of the heart adjacent to the diaphragm. It should properly be described, therefore, as being inferior and paraseptal. Pathways in this region can be ablated at three areas, which we term right inferior, mid-inferior, and left inferior paraseptal. The right- and left inferior paraseptal pathways connect the right and left atrial vestibules with the right and left paraseptal segments of the parietal ventricular walls. The mid-inferior paraseptal pathways take a subepicardial course from the myocardial sleeves surrounding the coronary sinus and its tributaries. Our review addresses the evolution of the anatomical concept of the inferior paraseptal region derived from surgical and catheter ablation procedures. We also highlight the limitations of the 12-lead electrocardiogram in identifying, without catheter electrode mapping, which are the pathways that can be ablated without a coronary sinus, or left heart approach.
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Affiliation(s)
- Jerónimo Farré
- Cardiology Department, Arrhythmia Unit, Fundación Jiménez Díaz University Hospital, Institute of Biomedical Research, Madrid, Spain
| | - Robert H Anderson
- Institute of Biosciences, Newcastle University, Newcastle upon Tyne, UK
| | - José-Manuel Rubio
- Cardiology Department, Arrhythmia Unit, Fundación Jiménez Díaz University Hospital, Institute of Biomedical Research, Madrid, Spain
| | - Justin T Tretter
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Camila García-Talavera
- Cardiology Department, Arrhythmia Unit, Fundación Jiménez Díaz University Hospital, Institute of Biomedical Research, Madrid, Spain
| | - Raghav Bansal
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - José-Angel Cabrera
- Unidad de Arritmias, Departamento de Cardiología, Hospital Universitario Quirón-Salud, Madrid, Spain.,Complejo Hospitalario Ruber Juan Bravo, Universidad Europea de Madrid, Madrid, Spain
| | - Hein J J Wellens
- CARIM-Cardiovascular Research Centre, Maastricht, Maastricht, The Netherlands
| | - Eduardo Back Sternick
- Arrhythmia and Electrophysiology Department, Biocor Instituto, Nova Lima, Minas Gerais, Brazil
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11
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Nasarre M, Strik M, Daniel Ramirez F, Buliard S, Marchand H, Abu-Alrub S, Ploux S, Haïssaguerre M, Bordachar P. Using a smartwatch electrocardiogram to detect abnormalities associated with sudden cardiac arrest in young adults. Europace 2021; 24:406-412. [PMID: 34468759 DOI: 10.1093/europace/euab192] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/08/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Smartwatch electrocardiograms (ECGs) could facilitate the detection of sudden cardiac arrest (SCA)-associated abnormalities. We evaluated the feasibility of using smartwatch-derived ECGs for detecting SCA-associated abnormalities in young adults and its agreement with 12-lead ECGs. METHODS AND RESULTS Twelve-lead and Apple Watch ECGs were registered in 155 healthy volunteers and 67 patients aged 18-45 years with diagnosis and ECG signs of long-QT syndrome (n = 10), Brugada syndrome (n = 12), ventricular pre-excitation (n = 19), hypertrophic cardiomyopathy (HCM, n = 13), and arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVC/D, n = 13). Cardiologists separately analysed 12-lead ECGs and the smartwatch ECGs taken from the left wrist (AW-I) and then from chest positions V1, V3, and V6 (AW-4). Compared with AW-I, AW-4 improved the classification of ECGs as 'abnormal', increasing the sensitivity from 64% to 89% (P < 0.01). Pre-excitation was detected in most cases using AW-I (sensitivity 89%) and in all cases using AW-4 (sensitivity 100%, P = 0.48 compared with AW-I, specificity 100% for both). Brugada was missed using AW-I but was detected in 11/12 patients using AW-4 (sensitivity 92%, specificity 100%, P = 0.003). Long QT was detected in 8/10 cases using AW-I (sensitivity 80%, specificity 100%) and in 9 patients using AW-4 (sensitivity 90%, specificity 100%, P > 0.99). Hypertrophic cardiomyopathy was correctly suspected using AW-I and AW-4 (sensitivity 92% and 85%, specificity 85%, and 100%, P > 0.99). AW-I was mostly (62%) considered normal in ARVC/D whereas AW-4 was useful in suspecting ARVC/D (100% sensitivity, 99% specificity, P = 0.004). CONCLUSIONS Detection of SCA-associated ECG abnormalities (pre-excitation, Brugada patterns, long QT, and signs suggestive of HCM and ARVC/D) is possible with an ECG smartwatch.
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Affiliation(s)
- Mathieu Nasarre
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France
| | - Marc Strik
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France
| | - Francisco Daniel Ramirez
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France.,Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Samuel Buliard
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France
| | - Hugo Marchand
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France
| | - Saer Abu-Alrub
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France
| | - Sylvain Ploux
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France
| | - Michel Haïssaguerre
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France
| | - Pierre Bordachar
- Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France
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12
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Prochnau D, Gabbert L, Sauer V, Küthe F, Eggers R, Yilmaz A. Wide QRS complex tachycardia due to typical atrial flutter with accessory pathway conduction. Herzschrittmacherther Elektrophysiol 2021; 32:380-382. [PMID: 34241682 DOI: 10.1007/s00399-021-00790-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/17/2021] [Indexed: 11/29/2022]
Abstract
A 62-year-old male patient was admitted with regular wide QRS complex tachycardia. After ajmaline administration, the heart rate slowed down disclosing atrial flutter with variable QRS morphologies. Electrocardiography after conversion to sinus rhythm showed narrow QRS complexes. Decremental atrial stimulation during electrophysiological study caused progressive pre-excitation. Spontaneously, typical atrial flutter occurred with pre-excited QRS complexes. Both accessory pathway and atrial flutter were ablated in the same session.
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Affiliation(s)
- D Prochnau
- Department of Internal Medicine I, Sophien- and Hufeland-Hospital Weimar, Henry-van-de-Velde-Straße 2, 99425, Weimar, Germany.
| | - L Gabbert
- Department of Internal Medicine I, Sophien- and Hufeland-Hospital Weimar, Henry-van-de-Velde-Straße 2, 99425, Weimar, Germany
| | - V Sauer
- Department of Internal Medicine I, Sophien- and Hufeland-Hospital Weimar, Henry-van-de-Velde-Straße 2, 99425, Weimar, Germany
| | - F Küthe
- Department of Internal Medicine I, Sophien- and Hufeland-Hospital Weimar, Henry-van-de-Velde-Straße 2, 99425, Weimar, Germany
| | - R Eggers
- Department of Internal Medicine I, Sophien- and Hufeland-Hospital Weimar, Henry-van-de-Velde-Straße 2, 99425, Weimar, Germany
| | - A Yilmaz
- Department of Internal Medicine II, Elisabeth Hospital Schmalkalden, Schmalkalden, Germany
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Nair KKM, Parashar NK, Shafeeq A, Namboodiri N, Valaparambil A. Shorter post pacing interval during initiation of regular narrow QRS tachycardia. What is the mechanism? J Electrocardiol 2021; 67:71-72. [PMID: 34090116 DOI: 10.1016/j.jelectrocard.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/23/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Krishna Kumar Mohanan Nair
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India.
| | - Nitin Kumar Parashar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India
| | - Ali Shafeeq
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India
| | - Narayanan Namboodiri
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India
| | - Ajitkumar Valaparambil
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India
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14
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Tunca Sahin G, Lewis M, Uzun O. Association of Fetal Atrial Flutter with Neonatal Atrioventricular Re-entry Tachycardia Involving Accessory Pathway: A Link to be Remembered. Pediatr Cardiol 2021; 42:849-856. [PMID: 33512546 DOI: 10.1007/s00246-021-02549-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 01/05/2021] [Indexed: 11/30/2022]
Abstract
To investigate prenatal and postnatal outcomes of atrial flutter and its association with the development of a second tachycardia, following restoration of sinus rhythm, in the fetus or newborn. This study is a retrospective review of all fetuses that presented with atrial flutter from January 2001 to December 2019 at the University Hospital of Wales, Cardiff, UK. The specific type of arrhythmia, its time of appearance and clinical characteristics, echocardiographic findings, medical management, and postnatal outcomes were evaluated. Sixteen fetuses were diagnosed with atrial flutter (AFL). Thirteen fetuses had persistent AFL and three fetuses had intermittent AFL. Seven patients had hydrops, of which one had Ebstein's anomaly and the other six had normal hearts. Three of the fetuses that presented with AFL were diagnosed at 20, 21, and 23 weeks' gestation and the remainder were diagnosed in the third trimester. Thirteen patients with AFL received antiarrhythmic drugs and three were delivered without any treatment. Five fetuses with AFL developed atrioventricular reciprocating tachycardia following DC cardioversion after birth, and four of them exhibited pre-excitation on the ECG. These five patients (31.3%) required postnatal antiarrhythmic treatment for up to 2 years. Pre-excitation disappeared in two patients during follow-up and two asymptomatic patients with neonatal pre-excitation required accessory pathway ablation. Fetal atrial flutter has a strong association with atrioventricular reciprocating tachycardia and ventricular pre-excitation in the neonatal period. Therefore, electrocardiograms should be carefully reviewed in newborns following the initial resolution of atrial flutter.
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Affiliation(s)
- Gulhan Tunca Sahin
- Department of Pediatric Cardiology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
| | - Michael Lewis
- Sport Sciences and Cardiovascular Research, Faculty of Engineering and Sport Sciences, Swansea University, Swansea, UK
| | - Orhan Uzun
- Sport Sciences and Cardiovascular Research, Faculty of Engineering and Sport Sciences, Swansea University, Swansea, UK.,University Hospital of Wales, Cardiff, UK.,School of Medicine, Cardiff University, Cardiff, UK
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15
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Nair KKM, Namboodiri N, Ganapathi S, Valaparambil A. Transition during radiofrequency ablation of manifest preexcitation. What is the mechanism? J Electrocardiol 2021; 66:49-53. [PMID: 33770648 DOI: 10.1016/j.jelectrocard.2021.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/15/2021] [Accepted: 02/28/2021] [Indexed: 11/30/2022]
Abstract
A 45-year-old lady was evaluated for recurrent episodes of palpitation. Her 12‑lead electrocardiogram (ECG) showed manifest but incomplete pre-excitation consistent with left sided accessory pathway. There was no structural heart disease by echocardiogram. She underwent an electrophysiology (EP) study after informed consent. A narrow QRS tachycardia consistent with orthodromic AV re-entry got induced. The accessory pathway was mapped to 2 'O clock of the mitral annulus (MA). While radio frequency ablation (RFA) was being performed at that site, an interesting phenomenon was observed (Figs. 1 & 2). What is the mechanism?
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Affiliation(s)
- Krishna Kumar Mohanan Nair
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram 695011, Kerala, India.
| | - Narayanan Namboodiri
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram 695011, Kerala, India
| | - Sanjay Ganapathi
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram 695011, Kerala, India
| | - Ajitkumar Valaparambil
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram 695011, Kerala, India
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16
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Kobayashi H, Tabata H, Shoin W, Okano T, Yoshie K, Okada A, Shoda M, Kuwahara K. A case of transient ventricular pre-excitation associated with takotsubo cardiomyopathy. J Electrocardiol 2021; 65:73-75. [PMID: 33556738 DOI: 10.1016/j.jelectrocard.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/29/2020] [Accepted: 01/14/2021] [Indexed: 11/30/2022]
Abstract
A 75-year-old woman, who had never exhibited a delta wave before, was diagnosed with sigmoid colon cancer and underwent surgical operation. Takotsubo cardiomyopathy (TC) occurred shortly after the operation. About 2 weeks following the onset of TC, a 12‑lead electrocardiogram revealed a delta wave that was present for 50 days, and the patient was diagnosed with transient ventricular pre-excitation. The delta wave disappeared prior to patient's discharge and was never observed thereafter. This transient appearance of a delta wave may be related to a pathological modulation of the autonomic nervous system during the acute phase of TC.
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Affiliation(s)
- Hideki Kobayashi
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Hiroaki Tabata
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Wataru Shoin
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Takahiro Okano
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Koji Yoshie
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan.
| | - Morio Shoda
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan.
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
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17
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Tapanainen JM, Insulander P, Drca N, Jemtrén A, Åkerström F, Jensen-Urstad M. Unmasking of pre-excitation after aortic valve surgery - A report of two cases. HeartRhythm Case Rep 2020; 7:178-181. [PMID: 33786316 PMCID: PMC7987896 DOI: 10.1016/j.hrcr.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jari M. Tapanainen
- Address reprint requests and correspondence: Dr Jari M. Tapanainen, Department of Cardiology, Karolinska University Hospital, S-171 76 Stockholm, Sweden.
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18
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Abstract
The new guidelines for the management of supraventricular tachycardia (SVT) were published by the European Society of Cardiology (ESC) in September 2019. The key message of the guidelines is that catheter ablation should be offered as a first line treatment to most patients during a comprehensive discussion of the risks and advantages. This recommendation recognizes that catheter ablation has nowadays become a widely established, effective and safe treatment method with a very low complication rate, which has revolutionized the treatment of SVT due to the substantial technical developments in recent years. The new guidelines also include a refinement of the recommendations for the use of antiarrhythmic drug treatment. Most of the previously used medications have been downgraded based on the currently available evidence situation. The recommendations suggest that with the exception of beta blockers and calcium channel blockers, most drugs used to treat SVT are proarrhythmogenic. The occurrence of SVT is associated with a higher risk of complications during pregnancy and the new guidelines provide new and specific recommendations for this patient group. It must be emphasized that all antiarrhythmic drugs should be avoided during the first trimester of pregnancy. It is important to realize that if drug treatment is ineffective, contraindicated or undesired, pregnant women with persistent or recurrent arrhythmia can now be treated with catheter ablation using new techniques that avoid exposing the patient and the fetus to hazardous levels of radiation.
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19
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Danon A, Militianu A, Schliamser JE. Cardioversion of pre-excited atrial fibrillation leading to ventricular fibrillation- case report and review of literature. Am J Emerg Med 2019; 37:1539-1543. [PMID: 31126668 DOI: 10.1016/j.ajem.2019.05.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 05/10/2019] [Accepted: 05/15/2019] [Indexed: 11/19/2022] Open
Abstract
Pre-excited, fast conducting atrial fibrillation (AF) is a serious life-threatening arrhythmia that requires urgent pharmacological or electrical cardioversion. When anti-arrhythmic medications fail to restore sinus rhythm, biphasic, direct current (DC) cardioversion is required. Appropriate synchronization of the DC shock with the QRS is crucial, however not easily achieved. Since the QRS-T complexes in pre-excited AF are severely distorted, the diagnosis of inaccurate synchronization may be overlooked. Here, we report a unique case where during electrical cardioversion of pre-excited AF with inappropriate synchronization on the T wave inadvertently resulted in ventricular fibrillation (VF), and review the literature.
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Affiliation(s)
- Asaf Danon
- Electrophysiology Unit, Cardiology Department, Hillel Yaffe Medical Center, Hadera, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion-IIT, Haifa, Israel.
| | - Arie Militianu
- Electrophysiology Unit, Division of Cardiology, Carmel Medical Center, Haifa, Israel
| | - Jorge E Schliamser
- Electrophysiology Unit, Division of Cardiology, Carmel Medical Center, Haifa, Israel
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20
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Giudici MC, Ahmad F, Holanda DG. Patient with a PRKAG2 mutation who developed Immunoglobulin A nephropathy: a case report. Eur Heart J Case Rep 2019; 3:5474965. [PMID: 31449595 PMCID: PMC6601182 DOI: 10.1093/ehjcr/ytz038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 03/12/2019] [Indexed: 11/28/2022]
Abstract
Background PRKAG2 syndrome (PS) is a rare, early-onset autosomal dominant inherited disease caused by mutations in PRKAG2, the gene encoding the regulatory γ2 subunit of adenosine monophosphate-activated protein kinase. PRKAG2 syndrome is associated with many cardiac manifestations, including pre-excitation, arrhythmias, left ventricular hypertrophy, and chronotropic incompetence frequently leading to early pacemaker placement. A meta-analysis of genome-wide association data in subjects with chronic kidney disease (CKD) identified a susceptibility locus in an intron of PRKAG2, which has been replicated in other studies. However, CKD has not been reported in patients with PS or mutations in PRKAG2. Case summary We report a case of a woman diagnosed at age 27 with PS when she presented with atrial fibrillation and pre-excitation on electrocardiogram. By age 35, she had developed mild renal insufficiency and a biopsy demonstrated IgA nephropathy (IGAN). Discussion This is the first reported case of IGAN in a patient with PS. We discuss both PS and IGAN and the potential mechanisms by which they could be related.
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Affiliation(s)
- Michael C Giudici
- Department of Medicine, University of Iowa Hospitals, 200 Hawkins Drive, 4426JCP, Iowa City, IA, USA
| | - Ferhaan Ahmad
- Department of Medicine, University of Iowa Hospitals, 200 Hawkins Drive, 4426JCP, Iowa City, IA, USA
| | - Danniele G Holanda
- Department of Pathology, University of Iowa Hospitals, 200 Hawkins Drive, 4426JCP, Iowa City, IA, USA
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21
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Staikou C, Stamelos M, Stavroulakis E. Perioperative management of patients with pre-excitation syndromes. Rom J Anaesth Intensive Care 2018; 25:131-147. [PMID: 30393770 PMCID: PMC6211613 DOI: 10.21454/rjaic.7518.252.stk] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/11/2018] [Indexed: 11/27/2022] Open
Abstract
Patients with pre-excitation abnormalities are at a high risk for life-threatening perioperative arrhythmias. In Wolff-Parkinson-White syndrome, the anaesthetics used for invasive diagnostic testing/ablation, should not affect cardiac electrophysiology; propofol, sevoflurane, fentanyl, sufentanil, alfentanil are suitable. In non-ablative surgery, propofol, sevoflurane, isoflurane, fentanyl, alfentanil, sufentanil have been used safely. Among neuromuscular blockers, cis-atracurium, rocuronium and vecuronium are good choices. Ketamine, pancuronium and pethidine should be avoided because of their sympathomimetic actions. Anticholinergic/ anticholinesterase combinations for neuromuscular block reversal should preferably be omitted, while sugammadex seems more attractive. In regional anaesthesia, addition of epinephrine and high sympathetic blocks should be avoided. Hypotension should be treated with pure alpha-adrenergic agonists. Other pre-excitation abnormalities associated with different accessory pathways are the Mahaim Fiber and Lown-Ganong-Levine syndrome. Sympathetic activation should be avoided. Total intravenous anaesthesia with propofol probably represents the safest option. A careful anaesthetic plan and close cooperation with cardiologists are mandatory for successful management.
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Affiliation(s)
- Chryssoula Staikou
- Department of Anaesthesiology, Aretaieio Hospital, Medical School, University of Athens, Athens, Greece
| | - Mattheos Stamelos
- Department of Anaesthesiology, Aretaieio Hospital, Medical School, University of Athens, Athens, Greece
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22
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López-Sainz Á, Salazar-Mendiguchía J, García-Álvarez A, Campuzano Larrea O, López-Garrido MÁ, García-Guereta L, Fuentes Cañamero ME, Climent Payá V, Peña-Peña ML, Zorio-Grima E, Jordá-Burgos P, Díez-López C, Brugada R, García-Pinilla JM, García-Pavía P. Clinical Findings and Prognosis of Danon Disease. An Analysis of the Spanish Multicenter Danon Registry. ACTA ACUST UNITED AC 2018; 72:479-486. [PMID: 30108015 DOI: 10.1016/j.rec.2018.04.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 04/23/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES Danon disease (DD) is caused by mutations in the LAMP2 gene. It is considered a multisystemic disease characterized by hypertrophic cardiomyopathy with pre-excitation and extreme hypertrophy, intellectual disability, myopathy, childhood presentation, and worse prognosis in men. There are scarce data on the clinical characteristics and prognosis of DD. METHODS We analyzed the clinical records of patients with DD from 10 Spanish hospitals. RESULTS Twenty-seven patients were included (mean age, 31 ± 19 years; 78% women). Male patients showed a high prevalence of extracardiac manifestations: myopathy (80%), learning disorders (83%), and visual alterations (60%), which were uncommon findings in women (5%, 0%, and 27%, respectively). Although hypertrophic cardiomyopathy was the most common form of heart disease (61%), the mean maximum wall thickness was 15 ± 7 mm and dilated cardiomyopathy was present in 12 patients (10 women). Pre-excitation was found in only 11 patients (49%). Age at presentation was older than 20 years in 16 patients (65%). After a median follow-up of 4 years (interquartile range, 2-9), 4 men (67%) and 9 women (43%) died or required a transplant. Cardiac disease and adverse events occurred later in women (37 ± 9 vs 23 ± 16 and 36 ± 20 vs 20 ± 11 years, respectively). CONCLUSIONS The clinical characteristics of DD differ substantially from traditional descriptions: age at presentation of DD is older, the disease is not multisystemic in women, and pre-excitation is infrequent.
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Affiliation(s)
- Ángela López-Sainz
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Joel Salazar-Mendiguchía
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Departamento de Genética, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Ana García-Álvarez
- Servicio de Cardiología, Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Oscar Campuzano Larrea
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Centro Genética Cardiovascular, Institut d'Investigacions Biomèdiques de Girona, Girona, Spain; Departamento Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain
| | - Miguel Ángel López-Garrido
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Luis García-Guereta
- Servicio de Cardiología Pediátrica, Hospital Universitario La Paz, Madrid, Spain
| | | | - Vicente Climent Payá
- Servicio de Cardiología, Hospital General Universitario de Alicante, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - María Luisa Peña-Peña
- Unidad de Imagen y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Esther Zorio-Grima
- Unidad de Cardiopatías Familiares, Muerte Súbita y Mecanismos de Enfermedad (CaFaMuSMe), Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Paloma Jordá-Burgos
- Servicio de Cardiología, Institut Clínic Cardiovascular, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Carles Díez-López
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ramón Brugada
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Centro Genética Cardiovascular, Institut d'Investigacions Biomèdiques de Girona, Girona, Spain; Departamento Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain; Unidad Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - José Manuel García-Pinilla
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Pablo García-Pavía
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, Madrid, Spain.
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Abstract
In humans, dominant mutations in the gene encoding the regulatory γ2-subunit of AMP-activated protein kinase (PRKAG2) result in a highly penetrant phenotype dominated by cardiac features: left ventricular hypertrophy, ventricular pre-excitation, atrial tachyarrhythmia, cardiac conduction disease, and myocardial glycogen storage. The discovery of a link between the cell's fundamental energy sensor, AMPK, and inherited cardiac disease catalyzed intense interest into the biological role of AMPK in the heart. In this chapter, we provide an introduction to the spectrum of human disease resulting from pathogenic variants in PRKAG2, outlining its discovery, clinical genetics, and current perspectives on its pathogenesis and highlighting mechanistic insights derived through the evaluation of disease models. We also present a clinical perspective on the major components of the cardiomyopathy associated with mutations in PRKAG2, together with less commonly described extracardiac features, its prognosis, and principles of management.
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Affiliation(s)
- Arash Yavari
- Experimental Therapeutics, Radcliffe Department of Medicine, University of Oxford, Oxford, UK. .,Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK. .,The Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK.
| | - Dhruv Sarma
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK.,The Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Eduardo B Sternick
- Instituto de Pós-Graduação, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
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24
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Paul EA, Mone SM, Liberman L. Revisiting Wolff-Parkinson-White risk stratification: a malignant arrhythmia in a patient with intermittent pre-excitation. Cardiol Young 2016; 26:781-3. [PMID: 26388223 DOI: 10.1017/S1047951115001754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
It has been reported that the presence of intermittent pre-excitation indicates low risk of rapid conduction via the accessory pathway in atrial fibrillation. We report a case of a 10-year-old boy with a history of intermittent pre-excitation who presented with atrial fibrillation with very rapid conduction.
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25
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Hafeez I, Sohail MM, Lone A, Gupta A, Iqbal K, Aslam K, Alai MS, Iqbal S. Low Voltage Electric Injury induced Atrial Fibrillation as a Presenting Feature of Wolff-Parkinson-White Syndrome: A Case Report. Oman Med J 2013; 28:e061. [PMID: 31011403 PMCID: PMC6458441 DOI: 10.5001/omj.2013.130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 08/04/2013] [Indexed: 11/20/2023] Open
Abstract
Electric injury can cause a variety of cardiac arrhythmias. Atrial fibrillation as a result of such injury is very rare. We present a case of a young asymptomatic patient who developed acute atrial fibrillation with antegrade conduction over the atrioventricular bypass tract and very high ventricular rate after accidental low voltage electric injury, which was reverted successfully by DC shock.
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Affiliation(s)
- Imran Hafeez
- Department of Cardilogy, Shere-Kashmir-Institute of Medical Sciences (SKIMS) Srinagar, J&K. 190011
| | - Mohd Maqbool Sohail
- Department of Cardilogy, Shere-Kashmir-Institute of Medical Sciences (SKIMS) Srinagar, J&K. 190011
| | - Ajaz Lone
- Department of Cardilogy, Shere-Kashmir-Institute of Medical Sciences (SKIMS) Srinagar, J&K. 190011
| | - Amit Gupta
- Department of Cardilogy, Shere-Kashmir-Institute of Medical Sciences (SKIMS) Srinagar, J&K. 190011
| | - Khurshid Iqbal
- Department of Cardilogy, Shere-Kashmir-Institute of Medical Sciences (SKIMS) Srinagar, J&K. 190011
| | - Khursheed Aslam
- Department of Cardilogy, Shere-Kashmir-Institute of Medical Sciences (SKIMS) Srinagar, J&K. 190011
| | - Mohd. S. Alai
- Department of Cardilogy, Shere-Kashmir-Institute of Medical Sciences (SKIMS) Srinagar, J&K. 190011
| | - Shamim Iqbal
- Department of Cardilogy, Shere-Kashmir-Institute of Medical Sciences (SKIMS) Srinagar, J&K. 190011
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